Relators Play Important Role in Exposing Copycat Healthcare Fraud Schemes

In November 2012, a clinical social worker filed a False Claims Act qui tam action against his former employer, home healthcare company. A year later, in November 2013, he filed a similar qui tam action against Centerlight Healthcare. In both cases, the whistleblower alleged that substandard social adult care services were provided to State New York Medicaid beneficiaries and that ineligible beneficiaries were enrolled into managed long-term care plans. Both of these cases recently settled, collectively recovering over $82 million for the Medicaid program. For his efforts, the whistleblower received whistleblower rewards totaling over $12 million.

Fraud schemes tend to permeate entire industries. As employees bounce from one employer to the next, they bring their business plans, tactics, and strategies with them. In competitive industries such as the healthcare sector, companies adopt the business strategies of the top performers. Unfortunately, however, when the lead player is skirting the rules (and the law), other companies, all too often, follow suit. When this occurs, the False Claims Act provides powerful incentives to encourage industry insiders to step forward with multiple qui tam actions.

More information for whistleblowers is located at the Nolan Auerbach & White website.

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